Looking for the top 10 health insurance companies in USA? The health insurance landscape is massive, with the leading providers contributing nearly $1.08 trillion in total net premiums in 2023 – an 8% increase from the previous year.
While the average American family pays $25,572 annually for group health coverage, the market remains dominated by a handful of insurance giants. UnitedHealth Group leads with a 15.34% market share and projects staggering revenues between $450-455 billion for 2025. Interestingly, Kaiser Permanente ranks as the largest health insurance company by enrollment with nearly 9 million members, despite operating in only eight states and Washington, D.C.
In this comprehensive guide, we’ll examine the largest health insurance companies in the US, their market positions, coverage options, and financial performance. Whether you’re shopping for the best health insurance or simply researching top rated health insurance companies, we’ve gathered everything you need to make an informed decision about these major health insurance providers.
UnitedHealth Group
Image Source: www.unitedhealthgroup.com
“UnitedHealthcare is dedicated to improving the value customers and consumers receive by improving health and wellness, enhancing the quality of care received, simplifying the health care experience and reducing the total cost of care.” — UnitedHealth Group, Largest health insurance company in the United States
UnitedHealth Group ranks as the undisputed titan among the largest health insurance companies in the US. Founded in 1977 and headquartered in Minnesota, this healthcare behemoth has consistently expanded its market presence through comprehensive service offerings and strategic growth.
UnitedHealth Group market share
At the forefront of major health insurance companies, UnitedHealth Group commanded a dominant 14% share of the U.S. health insurance market in 2022. This significant market position places it well ahead of competitors like Ellevance Health (12%) and CVS/Aetna (11%). The company’s steady expansion has solidified its status as the market leader among top health insurance companies in USA.
UnitedHealth Group coverage options
UnitedHealthcare, the insurance arm of UnitedHealth Group, offers a diverse portfolio of health benefit plans tailored to various demographic segments. For individuals and families, options include short-term plans and ACA Marketplace coverage with flexible benefits. Furthermore, their business is organized into specialized divisions:
- UnitedHealthcare Employer & Individual: Provides employer-sponsored health benefits and individual plans
- UnitedHealthcare Medicare & Retirement: Serves nearly 13.8 million consumers through Medicare Advantage, Medicare Part D, and Medicare Supplement plans
- UnitedHealthcare Community & State: Supports 7.5 million economically disadvantaged and medically underserved individuals
In 2024 alone, the company’s domestic commercial benefits segment grew by an impressive 2.4 million members. Additionally, UnitedHealthcare expanded its offerings for seniors and people with complex needs to 9.4 million members.
UnitedHealth Group premium revenue
As one of the best health insurance companies by financial performance, UnitedHealth Group generated staggering revenues of $371.60 billion in 2023, representing a 14.6% year-over-year growth. Subsequently, 2024 saw revenues climb to $400.30 billion, an 8% increase from the previous year.
Looking specifically at UnitedHealthcare’s contribution, the insurance segment delivered $281.40 billion in 2023, followed by $298.20 billion in 2024. This consistent financial growth underscores the company’s dominant position among the top rated health insurance companies in the market.
Elevance Health (Anthem)
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Formerly known as Anthem, Elevance Health stands as the second-largest player among major health insurance companies in the United States. The Indianapolis-based company continues to expand its footprint in the highly competitive healthcare market through its diverse portfolio of services.
Elevance Health market share
Commanding a significant 9.7-10% share of the U.S. health insurance market, Elevance Health consistently maintains its position as the second-largest insurer behind UnitedHealth Group. The company serves over 5.3 million health insurance members, contributing to the concentrated market dynamic where the top five largest insurance companies represent approximately 50% of the total U.S. market share. Indeed, Elevance Health’s total reach extends far beyond its direct insurance membership, with affiliated companies serving approximately 112 million consumers across the healthcare ecosystem.
Elevance Health coverage options
Elevance Health offers comprehensive coverage through various specialized plans:
- Individual & Family Plans: Available in 14 states with options across multiple price points and coverage levels
- Medicare Advantage: Serves nearly 2.1 million Medicare Advantage members as part of its 2.9 million total Medicare membership
- Specialty Plans: Offers Chronic Condition Special Needs Plans in 15 states and Institutional Special Needs Plans in 8 states
Notably, Elevance Health utilizes the extensive Blue Cross Blue Shield provider network, which includes approximately 90% of doctors and hospitals nationwide. Additionally, the company recently expanded its Medicare Advantage footprint, with 93% of eligible individuals in its service areas now having access to these plans.
Elevance Health premium revenue
As one of the largest health insurance companies in the US, Elevance Health generated impressive operating revenue of $175.20 billion in 2024, marking a 3% increase from the previous year. The Health Benefits segment alone contributed $150.30 billion, a 1% year-over-year growth. In fact, based on 2024 revenues, Elevance Health ranked 20th on the 2022 Fortune 500 list and secured the 78th position in the 2023 Forbes Global 2000. The company’s steady financial performance is further evidenced by its net income of $5.98 billion in 2024, reinforcing its status among the top rated health insurance companies in America.
Centene Corporation
Image Source: Investor Relations | Centene Corporation
With its roots as a single nonprofit Medicaid health plan in 1984, Centene Corporation has grown into the third-largest health insurance provider in America. Starting in the basement of a Milwaukee hospital, the company has expanded dramatically to become a cornerstone among major health insurance companies.
Centene Corporation market share
Centene Corporation holds a substantial 12.63% market share in the health insurance industry as of Q1 2025, positioning it firmly as the third-largest health insurance provider behind UnitedHealth Group and The Cigna Group. Within the Accident & Health Insurance segment specifically, Centene captures an even stronger 13.81% share. Moreover, the company’s market presence has shown steady quarterly improvement, increasing from 12.22% in Q4 2024 to 13.16% in Q1 2025, demonstrating its growing influence among the largest health insurance companies in the US.
Centene Corporation coverage options
As the largest Medicaid managed care organization in the nation, Centene serves approximately 13 million Medicaid members, down from 14.5 million prior to recent redeterminations. The company offers three primary coverage categories:
- Medicaid Plans: Partners with 30 state governments providing coverage to low-income adults, children, and pregnant women across Arizona, Arkansas, California, and 27 other states
- Medicare Advantage: Branded as Wellcare, these plans promote health independence with personalized care options
- Marketplace Coverage: Operating as Ambetter Health, serving 5.6 million members across 29 states with subsidized premiums for most enrollees
Alongside these core offerings, Centene emphasizes locally-branded health insurance plans with teams in every community they serve.
Centene Corporation premium revenue
Financially, Centene reported impressive total revenues of $169.28 billion for the 12 months ending Q1 2025. Premium and service revenues reached $145.50 billion for 2024, showing a 4% increase from $140.10 billion in 2023. This growth was primarily driven by strong expansion in the Marketplace business, which experienced a 12% membership increase compared to Q4 2023. Additionally, the company’s Medicare PDP segment saw an extraordinary 50% membership growth during the same period. Looking ahead, Centene has raised its 2025 premium and service revenue guidance by $4 billion, now anticipating between $158-160 billion, positioning it to maintain its status among the top health insurance companies in USA.
Humana
Image Source: Humana
As a frontrunner among the largest health insurance companies in the US, Humana focuses on putting health first for customers, teammates, and the organization itself. Through its insurance services and CenterWell healthcare offerings, the company streamlines healthcare delivery for millions of members.
Humana market share
Humana maintains a significant position in the health insurance landscape, ranking as the fourth or fifth largest insurer with approximately 6.03-6.61% of the national market share. Particularly impressive, Humana stands as the dominant insurer in 22% (84) of Metropolitan Statistical Areas across the country. This competitive positioning establishes Humana as one of the top health insurance companies in USA, particularly in specific regional markets where they’ve built strong provider relationships.
Humana coverage options
Humana’s diverse portfolio encompasses several specialized plans tailored to different customer needs:
- Medicare Advantage Plans: The company’s flagship offering includes all benefits of Original Medicare Parts A and B, with most plans including prescription drug coverage
- Individual and Family Plans: Available in 13 states including Alabama, Arizona, Florida, Georgia, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Tennessee, Texas, Utah, and Virginia
- Specialty Coverage: Additional dental and vision plans, plus life and supplemental insurance options
The company boasts an extensive healthcare network supporting these plans, with more than 350,000 medical providers and over 3,000 hospitals nationwide. Consequently, Humana received the highest Customer Experience Index scores among health insurers in Forrester’s 2024 rankings.
Humana premium revenue
Financially, Humana generated over $117 billion in total revenue for 2024, representing their highest recorded revenue and a significant increase from previous years. Looking ahead, the company projects consolidated GAAP revenues between $126-128 billion for 2025. Additionally, Humana’s Insurance segment is expected to generate between $121-123 billion in 2025. Despite projecting an individual Medicare Advantage membership decline of approximately 550,000 members in 2025, the company anticipates growth in other areas, particularly in Medicare stand-alone PDP (approximately 200,000 new members) and state-based contracts (175,000-250,000 range).
CVS Health (Aetna)
Image Source: Aetna CVS Health
Following the 2018 acquisition of health insurance giant Aetna, CVS Health emerged as a formidable player among the largest health insurance companies in the US. This strategic merger combined CVS’s pharmacy services with Aetna’s insurance expertise to create an integrated healthcare powerhouse.
CVS Health market share
Currently, CVS Health controls 12% of the U.S. health insurance market, positioning it as the fifth-largest health insurance provider nationwide. This significant market presence places the company among just four insurers that collectively command 50% of the entire market. Although CVS Health entered the insurance space more recently than some competitors, its acquisition of Aetna quickly established it as one of the major health insurance companies.
CVS Health coverage options
The company offers an extensive range of health insurance solutions:
- ACA Individual & Family Plans: Provides quality coverage through the Affordable Care Act with additional benefits like no-cost or low-cost MinuteClinic visits and prescription cost minimization
- Commercial Plans: Serves employer groups, individuals, college students, part-time workers, and labor groups with traditional and consumer-directed options
- Medicaid Coverage: Through Aetna Better Health, serves eligible low-income individuals across various demographics
- Medicare Advantage: Connects Medicare-eligible members with comprehensive health and wellness coverage
Throughout these offerings, members gain access to a nationwide network, over 1,000 MinuteClinic locations, in-home health support, and additional benefits.
CVS Health premium revenue
The company’s financial performance has been substantial, with Health Care Benefits segment revenues reaching $105.60 billion in 2023, marking a 15.6% increase from $91.40 billion in 2022. By Q3 2024, Aetna’s quarterly revenues climbed to $33.00 billion, up from $26.30 billion in Q3 2023. Nevertheless, the company recently announced plans to exit the ACA individual exchanges by 2026, citing underperformance in this segment. Accordingly, in 2024, its individual ACA plan business—representing over $10 billion in premium revenues—reported losses exceeding $1 billion.
Kaiser Permanente
Image Source: Kaiser Permanente
Unlike traditional insurers, Kaiser Permanente stands out as an integrated healthcare system combining insurance coverage and medical care in one seamless experience. Consistently rated among the top health insurance companies in USA, Kaiser’s unique approach has earned them the #1 overall rating among 60+ insurance carriers according to Insure.com’s “Best Health Insurance Companies of 2023”.
Kaiser Permanente market share
Kaiser Permanente dominates as the largest health insurance company by enrollment in the country, with nearly 9 million members holding either individual or group health insurance plans. Approximately 7 million of these members have employer-sponsored group health coverage. On the national level, Kaiser Permanente holds about 7% of the U.S. health insurance market share, placing it fifth among the largest health insurance companies. By the end of 2024, membership across Kaiser Permanente and Risant Health affiliates exceeded 13 million.
Kaiser Permanente coverage options
Kaiser Permanente provides a unified health experience where coverage and care work together. Their offerings include:
- Individual and Family Plans: Customized options with personalized care
- Medicare Plans: Highly-rated Medicare options with comprehensive benefits
- Employer Plans: Flexible coverage for businesses of all sizes
Members receive more than just health insurance; they gain access to personalized care plus tools designed to help them thrive. The organization currently operates 55 hospitals, 841 medical offices, and 40 retail and employee clinics, primarily in eight states and Washington, D.C.
Kaiser Permanente premium revenue
Kaiser Foundation Health Plan, Hospitals, and Risant Health reported combined operating revenues of $115.80 billion in 2024, a significant increase from $100.80 billion in 2023. Operating income reached $569 million in 2024, up from $329 million the previous year. Total net income surged to $12.90 billion in 2024, with $6.80 billion attributed to Risant Health acquisitions. The company completed strategic acquisitions of Geisinger (March 31, 2024) and Cone Health (December 1, 2024), expanding its value-based care model. Simultaneously, Kaiser invested $4.60 billion in community health programs in 2024 and provided over $1.40 billion in medical financial assistance to more than 1 million low-income patients.
Health Care Service Corporation (HCSC)
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Owned by its customers rather than shareholders, Health Care Service Corporation (HCSC) stands as the largest mutual legal reserve health insurer in America. This unique structure sets HCSC apart from many competitors among the largest health insurance companies in the US.
HCSC market share
Currently, HCSC holds approximately 3.53-3.65% of the national health insurance market share, positioning it as the fifth-largest health plan nationally based on membership and sixth-largest based on premiums. The company demonstrates remarkable dominance in its core states, commanding 45-70% commercial market share in the fully-insured large group segment. HCSC’s influence extends even further in specific markets, with estimated risk-based commercial market shares of 72% in Oklahoma, 70% in Texas, 69% in Illinois, 60% in Montana, and 52% in New Mexico. Significantly, HCSC is the only leading insurer to report gains in all five years from 2020-2024, adding 250,000 group risk members during this period.
HCSC coverage options
HCSC primarily serves five states through its Blue Cross Blue Shield divisions: Illinois, Montana, New Mexico, Oklahoma, and Texas. Throughout these regions, the company offers:
- Commercial plans: Representing 90% of membership as of 2023
- Medicare Advantage: Recently expanded to cover 82% of service areas
- Medicaid and Dual Special Needs: Reaching 1.17 million members by mid-2023
- Individual marketplace plans: Available through state-specific health insurance marketplaces
In 2022, HCSC announced its largest-ever service area expansion for 2023, increasing Medicare coverage options for approximately 1.1 million additional Medicare-eligible individuals across more than 150 new counties.
HCSC premium revenue
HCSC’s financial performance remains impressively robust, with total revenue reaching $54.75 billion in 2023, up from $49.30 billion in 2022. For 2024, this figure climbed even higher to $62.80 billion. The company’s steady growth stems from consistent membership expansion and strong investment portfolio performance. In 2023, HCSC maintained a net income of $1.45 billion, slightly down from $1.47 billion in 2022. Looking ahead, Standard & Poor’s projects revenue increases of 15-20% for 2024, primarily driven by strong membership growth across most segments, particularly in the individual marketplace.
Cigna Healthcare
Image Source: Cigna Healthcare
“The other way, however, was an overall performance that was, frankly, unusual and unacceptable.” — Andrew Witty, CEO of UnitedHealth Group
The Cigna Group has steadily climbed the ranks of America’s largest health insurance companies, positioning itself strategically through its healthcare-focused approach. As one of the top health insurance companies in USA, Cigna Healthcare provides comprehensive medical coverage while emphasizing personalized support and innovative care solutions.
Cigna Healthcare market share
Within the competitive landscape of major health insurance companies, Cigna Healthcare holds an 8.55% share of the overall insurance market as of Q1 2025. Interestingly, when focusing specifically on the Accident & Health Insurance industry, Cigna’s influence grows substantially to 20.70%. The company has shown modest yet consistent growth in recent quarters, improving from 8.45% to 8.71% market share between Q4 2024 and Q1 2025. This positions Cigna as the third-largest health insurer in America, behind UnitedHealth Group (13.46%) and CVS Health (12.68%).
Cigna Healthcare coverage options
Cigna offers diverse medical plans tailored to employer groups and individuals:
- Cigna Open Access Plus (OAP): Features a seamless national network with competitive discounts and steerage to high-value providers
- Preferred Provider Organization (PPO): Provides national coverage with flexibility for out-of-network care
- LocalPlus: Offers a limited network focused on value, delivering up to 18% savings over OAP
- Cigna SureFit: A hyper-local network available in select markets, offering up to 15% savings
- Health Maintenance Organization (HMO): Coordination through primary care physicians to improve outcomes
For individual consumers, Cigna provides plans with affordable virtual care starting at $3.00 and $0.00 preventive care. Their plans also include additional coverage for conditions like diabetes and asthma/COPD.
Cigna Healthcare premium revenue
Financially, The Cigna Group generated approximately $247 billion in total revenue for 2024. Though, Cigna Healthcare specifically saw more modest growth, with adjusted revenues increasing 3% in both Q4 and full-year 2024. Excluding the impact of lower Individual and Family Plans premiums, adjusted revenues for both periods increased by 6%. The company’s Medical Care Ratio was 87.9% for Q4 2024 and 83.2% for the full year, representing increases from 82.2% and 81.3% in the corresponding periods of 2023. This financial performance places Cigna firmly among the top rated health insurance companies in America.
Molina Healthcare
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Fortune 500 company Molina Healthcare specializes in government-sponsored healthcare programs, establishing itself as a key player among the major health insurance companies in America. With headquarters in Long Beach, California, this multi-state healthcare organization focuses primarily on serving low-income families and individuals.
Molina Healthcare market share
Currently, Molina Healthcare captures approximately 2.45% of the overall U.S. health insurance market. Within the Accident & Health Insurance industry specifically, the company’s influence expands to 3.42% market share. By comparison, within the broader Financial Sector, Molina maintains a 3.16% market share. The company has demonstrated consistent quarterly growth, improving from 2.44% to 2.49% market share between Q4 2024 and Q1 2025.
Molina Healthcare coverage options
Molina Healthcare offers various specialized coverage plans aimed at economically vulnerable populations:
- Medicaid Plans: The company’s core business, contracting with state governments to provide quality healthcare services to families qualifying for Medicaid and the State Children’s Health Insurance Program
- Medicare Advantage: Comprehensive plans with benefits including USD 0.00 prescriptions, dental allowances, vision coverage, and hearing aid coverage
- Dual Options (Medicare-Medicaid): Integrated plans coordinating both Medicare and Medicaid benefits with additional services like dental care, OTC health items, and transportation assistance
- Marketplace Plans: Available in nine states, offering subsidized commercial coverage for those ineligible for Medicaid without employer-sponsored insurance
Molina Healthcare premium revenue
Financially, Molina Healthcare generated approximately USD 32.50 billion in premium revenue for 2023, representing a 5% increase year over year. For 2024, the company projected premium revenue of USD 38.00 billion, a substantial 17% growth from 2023. Looking ahead, Molina anticipates premium revenue reaching approximately USD 42.00 billion for 2025. The company served 5.0 million members at the end of 2023, growing to 5.8 million members by March 2025. Essentially, this steady expansion has strengthened Molina’s position among the top health insurance companies in USA.
GuideWell (Florida Blue)
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As a regional powerhouse among top health insurance companies in USA, GuideWell stands out through its flagship brand Florida Blue, commanding extraordinary market dominance in its home state while steadily expanding its footprint nationwide. Backed by a 75-year history of stability and quality customer care, this health insurance giant has strategically positioned itself through targeted acquisitions and diversified healthcare offerings.
GuideWell market share
Currently, GuideWell holds approximately 1.84-1.91% of the national health insurance market, placing it 10th among the largest health insurance companies in the US. However, within Florida, GuideWell’s influence is vastly more significant, providing coverage for over 40% of commercially insured residents in Miami-Dade County. Similarly, the company dominates 43% of Broward County’s market and combines with UnitedHealth and CVS to control 75% of Hillsborough County. Most impressively, GuideWell holds 53.6% of Florida’s individual market share, making it the second-largest provider of individual commercial products nationally, behind only Centene.
GuideWell coverage options
The company delivers diverse health solutions through several specialized carriers:
- Florida Blue: The core business offering traditional medical coverage, mental health services, and preventive care
- Triple-S Salud: Puerto Rico’s largest health insurer with the first open access network plan on the island
- Truli for Health: Focused on affordable workforce coverage for Florida employers
- Florida Health Care Plans: Providing coverage for nearly 50 years
- Capital Health Plan: Serving the Tallahassee area with 135,000+ members
Their plan categories include Essential Plans with lower monthly premiums, HSA-compatible options, Everyday Plans with primary care copays, and All Copay Plans featuring $0 deductibles.
GuideWell premium revenue
GuideWell has experienced remarkable growth, with annual revenue reaching $32.4 billion in 2024, a substantial increase from $20 billion just two years earlier. Much of this expansion stems from strategic acquisitions, particularly the $900 million purchase of Triple-S Management in February 2022, which added approximately $4 billion in revenue. This acquisition propelled GuideWell into the top 10 Medicare Advantage insurers by enrollment for the first time and marked their first major entry into Medicaid through Triple-S’s coverage of 36% of Puerto Rico’s 1.3 million managed Medicaid members. Presently, GuideWell enterprises serve 38.5 million people across 50 states, Puerto Rico, and the U.S. Virgin Islands.
Independence Blue Cross
Image Source: www.ibx.com
Based in Philadelphia, Independence Blue Cross (IBX) has established a commanding presence throughout southeastern Pennsylvania as a key regional player in the health insurance industry. Operating as a licensee of the Blue Cross Blue Shield Association for approximately 80 years, this insurer has built remarkable market dominance in its service territory.
Independence Blue Cross market share
IBX wields exceptional influence in its home region, controlling 55% of Philadelphia County’s insured population. Even more impressive, when combined with CVS Health, these two insurers represent a staggering 74% of Philadelphia County’s insured enrollment. In neighboring Montgomery County, IBX demonstrates even stronger penetration, covering more than four times as many people as CVS, with the two insurers collectively representing nearly 82% of the county’s insured population. On a broader scale, IBX and Highmark together cover approximately 53% of Pennsylvania’s entire health insurance market. Beyond Pennsylvania’s borders, IBX maintains significant presence in New Jersey, where it stands as the second-largest insurer with 38% market share.
Independence Blue Cross coverage options
For individuals and families, IBX offers five distinct plan categories tailored to diverse needs:
- HMO plans require selection of a primary care physician to coordinate care
- PPO plans provide greater flexibility with out-of-network coverage
- EPO plans feature national access without referral requirements
- HMO Proactive utilizes a tiered network enabling members to choose when to save on care
- EPO Reserve combines PPO benefits with an optional health savings account
All IBX plans provide access to an extensive network including over 60,000 doctors and 180 hospitals throughout the region. Importantly, many members may qualify for tax credits to offset premium costs and out-of-pocket expenses.
Independence Blue Cross premium revenue
Independence Health Group, IBX’s parent company, reported consolidated revenue of $31.10 billion in 2023, representing a 13.6% increase from the previous year. Subsequently, revenue grew to $32.00 billion in 2024. When combined with claims paid for self-funded employers, health care funds under management reached $42.90 billion in 2023 and $44.00 billion in 2024. After achieving net income of $377.00 million (1.2% margin) in 2023, the company experienced a $239.00 million net loss (-0.7%) in 2024, primarily due to sharp increases in medical and pharmacy costs, especially in government programs.
Highmark Inc.
Image Source: Highmark
Serving as a regional giant among top rated health insurance companies, Highmark Inc. controls substantial market share across several mid-Atlantic states while delivering diverse coverage options through its extensive Blue-branded network. Among the largest health insurance companies in the US, Highmark maintains strong presence in multiple states with its community-focused approach.
Highmark market share
Throughout its core service areas, Highmark wields remarkable market dominance. In Delaware, the company’s market power reaches near-monopoly status with an astounding 99% of the individual market. Similarly, Highmark commands 52% market share in West Virginia and 31% in Pennsylvania, making it the largest commercial insurer in all three states. As of early 2025, Highmark Health Plans maintains 7.1 million members across Pennsylvania, Delaware, West Virginia, and western New York, solidifying its status among major health insurance companies in regional markets. Interestingly, in Allegheny County (Pittsburgh), Highmark and UPMC together cover nearly 85% of the insured population.
Highmark coverage options
Highmark offers comprehensive health insurance solutions through several specialized product lines:
- Individual & Family Plans: ACA-compliant coverage with cost-saving perks beneficial for both health and finances
- Medicare Plans: Wide-ranging Medicare Advantage options featuring no-cost wellness programs and dedicated customer support
- Medicaid Coverage: Plans covering essential services like lab tests, X-rays, transportation and home health services
- Dual Special Needs Plans (D-SNP): Specialized plans combining Medicare and Medicaid benefits while providing extra assistance with prescriptions and utility bills
Alongside these core offerings, Highmark provides GeoBlue international coverage for those traveling abroad.
Highmark premium revenue
Financially, Highmark Health Plans reported $22 billion in operating revenue for 2024, though facing operating losses of $166 million. Since 2013, Highmark has invested more than $3 billion in the Allegheny Health Network, with $825 million dedicated to solutions, technology, and facilities in 2023 alone. The organization’s economic impact extends beyond its premium revenue, contributing approximately $20.60 billion annually to the national economy, primarily in Pennsylvania, West Virginia, Delaware, and western New York.
Blue Cross Blue Shield of Michigan
Image Source: Blue Cross Blue Shield of Michigan
Originally founded in 1939, Blue Cross Blue Shield of Michigan stands as the largest health insurance company in Michigan, operating as a nonprofit mutual insurance company. As a primary licensee of the Blue Cross Blue Shield Association, this insurer delivers substantial coverage throughout the state while maintaining a distinctive community focus.
BCBS Michigan market share
Throughout Michigan’s health insurance landscape, BCBS Michigan dominates with an extraordinary 67% market share, positioning it among the top health insurance companies in USA. Within the individual market specifically, BCBS Michigan Group controls 57% of enrollments, demonstrating overwhelming influence. With over 6.1 million members receiving care, this insurer ranks as one of the largest health insurance companies in the US on a regional basis. Notably, Michigan’s health insurance market ranks as the second least competitive in the nation, further highlighting BCBS Michigan’s commanding position.
BCBS Michigan coverage options
Beyond basic coverage, BCBS Michigan offers diverse plan options tailored to various needs:
- HMO and PPO plans: Providing flexibility across different service models
- Prescription drug plans: Comprehensive medication coverage
- Plans with health spending accounts: For cost-conscious consumers
- Medicare solutions: Including PPO, HMO, PDP, and Medicare supplement options
All members benefit from access to Michigan’s largest provider network, featuring 152 hospitals and more than 33,000 physicians statewide. As the only carrier on the Marketplace with four-star ratings for both PPO and HMO plans, BCBS Michigan emphasizes quality alongside accessibility.
BCBS Michigan premium revenue
In terms of finances, BCBS Michigan reported consolidated revenue of $40.60 billion in 2024, up substantially from $36.30 billion in 2023. Nevertheless, the company experienced significant challenges, posting an operating margin of negative 4.2%, equating to an operating loss of $1.70 billion. This resulted from a staggering $3.00 billion increase in medical and pharmacy claims costs during 2024, culminating in a bottom-line loss of $1.02 billion. Previously, in 2023, the company had achieved a marginally positive net gain of $100 million despite rising healthcare costs.
Blue Cross Blue Shield of North Carolina
Image Source: Blue Cross NC
As North Carolina’s preeminent health insurance provider, Blue Cross Blue Shield of North Carolina (Blue Cross NC) wields exceptional influence throughout the state’s healthcare landscape. Operating as a not-for-profit company since 1933, this insurer has built a reputation for making healthcare more navigable, affordable, and accessible.
BCBS North Carolina market share
Blue Cross NC dominates as the largest health insurer in North Carolina, controlling an impressive 48% of the state’s overall market. Its grip on specific segments is even more pronounced, covering approximately 83% of the individual market and nearly 80% of the group health insurance market. Currently, more than 4 million North Carolinians receive coverage through Blue Cross NC. Of these, roughly 2.3 million obtain insurance directly from the company, alongside 2 million more enrolled through employer-sponsored plans that Blue Cross NC administers. Additionally, half a million Medicaid recipients have Blue Cross NC as their managed care organization.
BCBS North Carolina coverage options
The company offers diverse plans tailored to various coverage needs. All Blue Cross NC plans include preventive services covered at 100% when using in-network providers. Members gain access to extensive wellness resources through the Healthy Outcomes portal and enjoy discounts via the Blue365 program. In terms of accessibility, Blue Cross NC maintains an exceptional network covering 99% of hospitals in North Carolina and 91% of physicians and specialists. Core coverage encompasses laboratory services, emergency care, prescriptions, mental health services, hospitalization, ambulatory services, maternity care, and pediatric services—all without upper benefit limits.
BCBS North Carolina premium revenue
Financially, Blue Cross NC reported revenue of $10.9 billion in 2022. That same year, the company generated net income of $36.2 million alongside $9 billion in claims and medical expenses. Throughout 2022, membership grew by 2.4% to nearly 4.4 million, including expansion of its Healthy Blue Medicaid segment to more than 495,000 members. As a community-focused organization, Blue Cross NC has donated over $200 million to combat hunger, homelessness, and hardship across North Carolina.
CareSource
Image Source: CareSource
Focusing exclusively on underserved communities, CareSource distinguishes itself among major health insurance companies as a nonprofit organization with 2.1 million members nationwide. Operating since its founding as a Medicaid managed care plan, this mission-driven insurer has expanded to become one of the largest Medicaid managed care plans in America.
CareSource market share
Within the health insurance landscape, CareSource maintains a significant presence across eight states, primarily serving Medicaid managed care and Marketplace members, along with individuals dually eligible for Medicare and Medicaid in select regions. The company has steadily expanded its footprint, now offering specialized coverage through various programs:
- Medicaid PASSE in Arkansas for members with complex behavioral health and developmental disabilities
- Medicaid and Marketplace in Indiana, with plans available in all 92 counties
- Medicaid, Marketplace, and Dual-Eligible D-SNP in Georgia and Ohio
- Marketplace-only options in Kentucky, Michigan, North Carolina, and West Virginia
CareSource coverage options
All CareSource plans cover medically necessary Medicaid-covered services plus expanded benefits. Their Marketplace offerings include three different Silver plans designed to fit various budgets. Meanwhile, their optional benefits package enhances Gold, Silver, and Bronze plans with adult dental, vision, and fitness programs for a slightly higher premium. For Medicare-eligible individuals, CareSource provides primary, acute behavioral health, and long-term care services.
CareSource premium revenue
Financially, CareSource reported $11.10 billion in annual revenue, distributed across its various programs. Approximately $8.90 billion came from Medicaid services, while $1.00 billion originated from complex specialty populations also covered by Medicaid. Furthermore, Marketplace coverage contributed roughly $1.20 billion to the company’s overall revenue. Given that CareSource operates as a nonprofit, it reinvests additional dollars back into communities, members, and innovation rather than distributing to investors. This approach has fueled continuous growth and allowed for substantial community investment, including $32.00 million in grants distributed through the CareSource Foundation.
UPMC Health Plan
Image Source: UPMC Health Plan
Representing a unique model among top health insurance companies in USA, UPMC Health Plan combines a major healthcare provider and insurer under one umbrella. This integrated approach allows the organization to align quality care delivery with affordable coverage options across Pennsylvania and beyond.
UPMC market share
Dominating western Pennsylvania’s insurance landscape, UPMC Insurance Services commands an impressive 43% medical-surgical market share across 29 counties. The division has experienced substantial growth, reaching more than 4.5 million members in 2024, an 11% increase over previous years. Throughout rural Pennsylvania regions, UPMC’s dominance extends across larger geographic areas with several markets showing overwhelming presence—89% market share in Altoona and a remarkable 94% in Williamsport. Interestingly, in Allegheny County alone, UPMC provides coverage for 57% of residents.
UPMC coverage options
UPMC Health Plan offers diverse insurance products catering to virtually every demographic:
- UPMC for You: Their Medicaid program serving over 500,000 members
- Medicare Plans: UPMC for Life maintains market leadership in western Pennsylvania for both Medicare Advantage Individual and Special Needs plans
- Individual & Family Plans: Through Pennie (Pennsylvania’s insurance marketplace), enrolled 31,000+ new members while retaining 93% of existing membership
- UPMC for Kids: CHIP plan covering children in 64 of Pennsylvania’s 67 counties
Plus, members gain access to top-ranked doctors, hospitals, and nationwide coverage through the Cigna Healthcare PPO Network. Therefore, UPMC Health Plan earned the highest satisfaction score in Pennsylvania in the J.D. Power 2024 U.S. Commercial Member Health Plan Survey.
UPMC premium revenue
As the nation’s second-largest provider-owned health plan, UPMC demonstrates consistent financial strength. Their premium revenue has grown steadily with an 11.3% compound annual growth rate over five years. The Medicaid line contributes significantly to this expansion, showing a 27% five-year growth rate through statewide expansion and organic growth. Besides strong enrollment, UPMC maintains exceptional membership retention—97.7% for Medicare Advantage and 96.0% for special needs plans.
Point32Health
Image Source: New England Council
Born from the 2021 merger of Harvard Pilgrim Health Care and Tufts Health Plan, Point32Health has carved out a niche within the competitive landscape of major health insurance companies, focusing on delivering comprehensive care options across New England.
Point32Health market share
In terms of national presence, Point32Health captures a modest 0.57% of the overall U.S. health insurance market, positioning it 24th among the largest health insurance companies in the US. Currently serving approximately 2 million members as of late 2023, the company’s membership has experienced slight growth to 2.1 million by mid-2024. Point32Health maintains strong regional influence throughout Massachusetts, New Hampshire, Maine, and Rhode Island, where its legacy organizations have operated for decades.
Point32Health coverage options
Point32Health introduced four distinctive Harvard Pilgrim plans for 2024, all featuring streamlined access without primary care physician requirements or specialist referrals. These options include:
- Access America Value No Deductible: Providing in-network coverage only with no annual deductible
- Access America Value with Deductible: Offering in-network coverage with a $1,000 individual/$2,000 family deductible
- Access America with Deductible: Including both in-network and out-of-network coverage
- Access America HSA with Deductible: Featuring an HSA option with preventive drug benefits
Interestingly, all plans provide pharmacy benefits through Premium 4-Tier formulary coverage. Beyond medical coverage, Point32Health recently expanded into dental and vision products for large group employer clients, alongside launching a behavioral health service navigation program offering personalized support to members seeking behavioral health care.
Point32Health premium revenue
Throughout 2023, Point32Health reported an adjusted net loss of $176 million, with revenues reaching $9.4 billion. Financial challenges have continued into 2024, with the company reporting an adjusted net loss of $100 million during the first half of the year on revenues of $4.7 billion. Despite these difficulties, Point32Health maintains a substantial operation with estimated revenue per employee of $344,507 across its workforce of 1,932 employees. Chief Financial Officer Scott Walker cited “elevated health care costs driven by increased utilization” including pharmacy expenses and GLP-1 weight loss drugs as key factors affecting financial performance.
Health Net of California
Image Source: Health Net
As Centene’s California arm, Health Net of California delivers healthcare coverage to millions of residents throughout the Golden State, standing among the major health insurance companies serving the western region. First established to expand accessible healthcare options, this insurer has grown into a significant market presence.
Health Net market share
At present, Health Net of California maintains a substantial membership base of 2,228,523 Californians as of March 2024. Within the broader Centene corporate structure, Health Net contributes to an impressive overall membership of 28.4 million members. Across California’s complex healthcare landscape, Health Net distributes its influence through multiple entities—Health Net Community Solutions primarily handles public business, whereas Health Net of California focuses on commercial lines. In terms of financial impact, California’s health insurance market saw total revenues of $67.70 billion concentrated under the Department of Managed Health Care (DMHC), with Health Net capturing a meaningful portion of this market.
Health Net coverage options
The company offers a diverse portfolio of plans customized for various population segments:
- Medi-Cal: No-cost and low-cost coverage regardless of immigration status, featuring large networks with thousands of doctors statewide plus dental and vision benefits
- Medicare Advantage: Marketed as Wellcare By Health Net with access to a large provider network, caring case managers, and nurse hotline
- Ambetter from Health Net: Individual and family plans available through Covered California with potential financial assistance
- Employer Plans: Both large employer and small business options with comprehensive benefits
Uniquely among competitors, Health Net serves as the only Medi-Cal plan in Los Angeles and Sacramento counties offering both medical and dental coverage.
Health Net premium revenue
In terms of financial performance, Health Net’s parent company Centene projects 2024 premium and service revenues between $135.50-$138.50 billion, reflecting steady growth from 2023’s reported revenue of over $144 billion. Currently, the company maintains substantial financial reserves with $37.50 billion in cash and investments. For its California operations specifically, Health Net collected $1,216,908,798 in premium revenue during 2021, resulting in a loss ratio of 84.0% inclusive of risk transfer payments. As a result of strategic planning, the company’s 2023 California membership decreased from approximately 3,148,553 to 2,228,523 by March 2024, likely reflecting targeted portfolio adjustments.
Comparison Table
| Insurance Company | Market Share (%) | Annual Revenue (Recent) | Total Membership | Key Coverage Types | Notable Market Position |
|---|---|---|---|---|---|
| UnitedHealth Group | 14% | $400.30B (2024) | Not mentioned | Employer & Individual, Medicare & Retirement, Community & State | Largest health insurer in US; 15.34% market share |
| Elevance Health | 9.7-10% | $175.20B (2024) | 5.3M direct (112M through affiliates) | Individual & Family, Medicare Advantage, Specialty Plans | Second-largest insurer; present in 14 states |
| Centene Corporation | 12.63% | $169.28B (Q1 2025) | 13M Medicaid | Medicaid, Medicare Advantage, Marketplace | Largest Medicaid managed care organization |
| Humana | 6.03-6.61% | $117B (2024) | Not mentioned | Medicare Advantage, Individual & Family, Specialty Coverage | Dominant in 84 Metropolitan Statistical Areas |
| CVS Health (Aetna) | 12% | $105.60B (2023) | Not mentioned | Commercial, Medicare Advantage, Medicaid, Individual | Fifth-largest health insurance provider |
| Kaiser Permanente | 7% | $115.80B (2024) | 9M direct (13M total) | Individual & Family, Medicare, Employer Plans | Largest by enrollment; operates in 8 states + DC |
| HCSC | 3.53-3.65% | $62.80B (2024) | Not mentioned | Commercial, Medicare Advantage, Medicaid, Individual | Largest mutual legal reserve health insurer |
| Cigna Healthcare | 8.55% | $247B (2024) | Not mentioned | OAP, PPO, LocalPlus, HMO, SureFit | Third-largest health insurer in America |
| Molina Healthcare | 2.45% | $32.50B (2023) | 5.8M | Medicaid, Medicare Advantage, Marketplace, Dual Options | Specializes in government-sponsored programs |
| GuideWell | 1.84-1.91% | $32.40B (2024) | 38.5M across enterprises | Florida Blue, Triple-S Salud, Truli for Health | Controls 53.6% of Florida’s individual market |
| Independence Blue Cross | Not mentioned | $32B (2024) | Not mentioned | HMO, PPO, EPO, HMO Proactive | Controls 55% of Philadelphia County’s market |
| Highmark Inc. | Not mentioned | $22B (2024) | 7.1M | Individual & Family, Medicare, Medicaid, D-SNP | 99% market share in Delaware |
| BCBS Michigan | 67% | $40.60B (2024) | 6.1M | HMO, PPO, Medicare, Prescription plans | Largest insurer in Michigan |
| BCBS North Carolina | 48% | $10.90B (2022) | 4.4M | Not mentioned | Controls 83% of individual market in NC |
| CareSource | Not mentioned | $11.10B | 2.1M | Medicaid, Marketplace, Medicare-Medicaid | Operates in 8 states |
| UPMC Health Plan | 43% (Western PA) | Not mentioned | 4.5M | Medicaid, Medicare, Individual & Family, CHIP | Second-largest provider-owned health plan |
| Point32Health | 0.57% | $9.40B (2023) | 2.1M | Access America plans, dental, vision | Regional focus in New England |
| Health Net of California | Not mentioned | Not mentioned | 2.2M | Medi-Cal, Medicare Advantage, Ambetter, Employer Plans | Major presence in California market |
Conclusion
The American health insurance market undoubtedly represents one of the most complex and concentrated healthcare systems worldwide. Throughout this comprehensive analysis, we’ve seen how the top 25 health insurance companies control different segments of a trillion-dollar industry. UnitedHealth Group clearly dominates with its 14% market share and over $400 billion in annual revenue, followed closely by Elevance Health, Centene, Humana, and CVS Health completing the top five insurers.
What stands out most notably is the regional dominance many insurers maintain. Blue Cross Blue Shield of Michigan commands an extraordinary 67% of its state market, while Highmark holds a near-monopoly in Delaware with 99% market share. Similarly, regional players like GuideWell control over half of Florida’s individual market, demonstrating how geography significantly shapes competition.
Another key point worth emphasizing relates to specialization. Centene focuses primarily on government-sponsored programs as America’s largest Medicaid managed care organization, whereas Kaiser Permanente distinguishes itself through its integrated provider-insurer model. This specialization allows different insurers to carve out specific niches within the broader market.
The financial scale of these companies is equally impressive. Eight of the profiled insurers generate annual revenues exceeding $50 billion, with Cigna Healthcare reporting a staggering $247 billion. These figures reflect both the enormous cost of American healthcare and the substantial resources these companies control.
Although navigating health insurance options can feel overwhelming, understanding the major players, their market positions, and coverage specialties provides valuable context for consumers, employers, and healthcare providers alike. This knowledge becomes particularly important when selecting plans that best align with specific healthcare needs and geographic considerations.
FAQs
Q1. Which are the top 5 health insurance companies in the United States? Based on market share and revenue, the top 5 health insurance companies in the US are UnitedHealth Group, Elevance Health (formerly Anthem), Centene Corporation, Humana, and CVS Health (including Aetna).
Q2. What is the largest health insurance company by enrollment? Kaiser Permanente is the largest health insurance company by enrollment, with nearly 9 million members holding either individual or group health insurance plans directly through the company.
Q3. How does market dominance vary by region for health insurance companies? Market dominance can vary significantly by region. For example, Blue Cross Blue Shield of Michigan controls 67% of its state market, while Highmark holds 99% market share in Delaware. GuideWell dominates 53.6% of Florida’s individual market.
Q4. Which health insurance company specializes in government-sponsored programs? Centene Corporation specializes in government-sponsored healthcare programs. It is the largest Medicaid managed care organization in the nation, serving approximately 13 million Medicaid members.
Q5. How do integrated healthcare systems differ from traditional insurers? Integrated healthcare systems like Kaiser Permanente combine insurance coverage and medical care in one seamless experience. This approach allows for better coordination between insurance and healthcare delivery, potentially leading to improved patient outcomes and cost efficiencies.
